Shocking story from the Poughkeepsie Journal:

State institutions for the developmentally disabled generate so much federal Medicaid money that New York’s other programs for people with intellectual disabilities would be threatened without them, state officials acknowledge in an internal document obtained by the Poughkeepsie Journal.

The document, labeled “Confidential — Policy Advice,” raises questions about the state’s decision to keep 1,100 institutional beds at eight centers that were once slated to close. The goal of the five-page paper, an undated PowerPoint presentation with recent statistical data, was to “preserve [the] status quo” by heading off potential regulatory reforms such as the federal government’s 2008 attempt to curb Medicaid payments.

“Without continuation of this system,” the presentation states, “roughly $1.4 billion in annual federal funding that is currently used to support vital community and other services … would be lost.”

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The controversy surrounding the recent mammography guidelines issued by the U.S. Preventive Services Task Force is a recommendation for swift and decisive defeat of efforts to expand federal oversight of health care.  It almost seems as if this was designed as a laboratory experiment to learn exactly what will happen under Obamacare.  The results validate some of the most compelling arguments that opponents have made over the past few months.

When opponents claim that Obamacare will lead to rationing of medical services, defenders counter with an irrelevant but true retort that care is already rationed by insurance companies.  By this logic, everything is rationed by economics.  Housing is rationed by the availability of capital to invest in housing which is a collective market choice.  Cars are rationed in that you can’t just walk into a dealer and drive off the lot.  So, yes, currently the health care market, mostly in the form of third-party payers (insurers and public programs), rations care in that there are finite resources to pay for treatments and everyone cannot have everything any time they wish.

The reason that argument is irrelevant is that the debate here is about government rationing of care, which represents an entire new level of restrictions on individuals.  When the government sets up panels of “experts” to make recommendations of what kind of care is appropriate under what circumstances and those recommendations are implemented in the form of regulations over what care will and will not be paid for by both private and public insurance, it limits the rights of patients to control their care in consultation with their physicians.  It also destroys the market for those excluded treatments which then become either prohibitively expensive or entirely unavailable.

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There has been a lot of talk about Sen. Mary Landrieu’s new-found 100 million reasons to support Sen. Reid’s health care bill. As she channeled her inner-Hamlet about whether or not she would support her majority Leader on a procedural vote today, Sen. Landrieu won language that would pump at least another $100 million into Louisiana’s Medicaid system.

Many have framed this as Sen. Landrieu “selling” her vote, which makes me think that she’s a pretty cheap date. When fully implemented, the Reid health care plan–under the most optimistic assumptions–will cost at least $200 billion a year. An extra $100 million here or there is a rounding error. $100 million is what you get to vote for the Postal Reauthorization, not the most sweeping revamp of our nation’s health care delivery system. If I were cast in the role of one of the “undecideds” on this bill, which to Sen. Reid is numbers one, two and three on his priority list, I’d hold out for at least $1 billion. But then, I’m from Illinois.

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